Kim Yongjung J, Bridwell Keith H, Lenke Lawrence G, Rhim Seungchul, Cheh Gene
Washington University Medical Center, St. Louis, MO, USA.
Spine (Phila Pa 1976). 2006 Sep 15;31(20):2329-36. doi: 10.1097/01.brs.0000238968.82799.d9.
Retrospective study.
To analyze the incidence of and risk factors for pseudarthrosis in long adult spinal instrumentation and fusion to S1.
Few studies on pseudarthrosis in long adult spinal instrumentation and fusion to S1 exist.
A clinical and radiographic assessment of 144 adult patients with spinal deformity (average age 52.0 years; range 21.1-77.6) who underwent long (5-17 vertebrae, average 11.9) spinal instrumentation and fusion to the sacrum at a single institution between 1985 and 2002, with a minimum 2-year follow-up (average 3.9; range 2-14) was performed.
Of 144 patients, 34 (24%) had pseudarthroses. There were 17 patients who had pseudarthroses at T10-L2 and 15 at L5-S1. A total of 24 patients (71%) presented with multiple levels involved (2-6). Pseudarthrosis was most commonly detected within 4 years postoperatively (31 patients; 94%). Factors that statistically increased the risk of pseudarthrosis were: thoracolumbar kyphosis (T10-L2 > or = 20 degrees vs. < 20 degrees, P < 0.0001); osteoarthritis of the hip joint (P = 0.002); thoracoabdominal approach (vs. paramedian approach, P = 0.009); positive sagittal balance > or = 5 cm at 8 weeks postoperatively (vs. < or = 5 cm, P = 0.012); age at surgery older than 55 years (vs. 55 years or younger, P = 0.019); and incomplete sacropelvic fixation (vs. complete sacropelvic fixation, P = 0.020). Fusion from upper thoracic spine (T2-T5) did not statistically increase the pseudarthrosis rate compared to lower thoracic spine (T9-T12) (P = 0.20). Patients with pseudarthrosis had significantly lower Scoliosis Research Society 24 outcome scores (average score 71/120) than those without (average score 90/120; P < 0.0001) at ultimate follow-up.
The overall prevalence of pseudarthrosis following long adult spinal deformity instrumentation and fusion to S1 was 24%. Thoracolumbar kyphosis, osteoarthritis of the hip joint, thoracoabdominal approach (vs. paramedian approach), positive sagittal balance > or = 5 cm at 8 weeks postoperatively, older age at surgery (older than 55 years), and incomplete sacropelvic fixation significantly increased the risks of pseudarthrosis to an extent that was statistically significant. Scoliosis Research Society 24 outcomes scores at ultimate follow-up were adversely affected when pseudarthrosis developed.
回顾性研究。
分析成年患者长节段脊柱内固定并融合至S1术后假关节形成的发生率及危险因素。
关于成年患者长节段脊柱内固定并融合至S1术后假关节形成的研究较少。
对1985年至2002年间在单一机构接受长节段（5 - 17个椎体，平均11.9个）脊柱内固定并融合至骶骨的144例成年脊柱畸形患者（平均年龄52.0岁；范围21.1 - 77.6岁）进行临床及影像学评估，随访时间至少2年（平均3.9年；范围2 - 14年）。
144例患者中，34例（24%）发生假关节形成。T10 - L2节段假关节形成17例，L5 - S1节段15例。共有24例患者（71%）存在多个节段受累（2 - 6个节段）。假关节形成最常于术后4年内被发现（31例；94%）。统计学上增加假关节形成风险的因素包括：胸腰段后凸（T10 - L2≥20°对比＜20°，P＜0.0001）；髋关节骨关节炎（P = 0.002）；胸腹联合入路（对比旁正中入路，P = 0.009）；术后8周矢状面平衡阳性≥5 cm（对比≤5 cm，P = 0.012）；手术年龄大于55岁（对比55岁及以下，P = 0.019）；以及骶骨盆固定不完整（对比完整骶骨盆固定，P = 0.020）。与下胸段（T9 - T12）相比，上胸段（T2 - T5）融合在统计学上未增加假关节形成率（P = 0.20）。在最终随访时，发生假关节形成的患者脊柱侧凸研究学会24项结果评分（平均评分71/120）显著低于未发生假关节形成的患者（平均评分90/120；P＜0.0001）。
成年患者长节段脊柱畸形内固定并融合至S1术后假关节形成的总体发生率为24%。胸腰段后凸、髋关节骨关节炎、胸腹联合入路（对比旁正中入路）、术后8周矢状面平衡阳性≥5 cm、手术年龄较大（大于55岁）以及骶骨盆固定不完整均显著增加假关节形成风险，且具有统计学意义。当发生假关节形成时，最终随访时的脊柱侧凸研究学会24项结果评分受到不利影响。
